Article Archive
January/February 2024

Alzheimer’s Disease: Coaching on Lifestyle Interventions Can Slow Cognitive Decline
By Lindsey Getz
Today’s Geriatric Medicine
Vol. 17 No. 1 P. 28

The latest research on Alzheimer’s disease is trending in the direction of lifestyle changes. A study published online in the Journal of Alzheimer’s Disease found that patients who received lifestyle coaching (including coaching on diet, exercise, and cognitive training) derived cognitive benefits generally not seen in studies of Alzheimer’s medications.

There’s been a strong push toward better understanding how lifestyle influences cognitive health. How exactly can healthy habits affect the brain?

“We have spent billions trying to find a medication to slow the progression of Alzheimer’s, but those attempts have not been wildly successful,” says Mouna Attarha, PhD, a senior scientist at Posit Science who was on the consortium for this study. The cognitive training in this trial was performed using BrainHQ, a platform of online brain exercises developed by Posit Science.

“Now, the landscape is changing,” she continues. “What we’ve learned so far is that Alzheimer’s is not a singular disease—instead, it is caused by many things going wrong in the body. Attacking it from multiple angles may give us the best chance at success.”

This is where lifestyle changes come into play, Attarha says. This two-year trial looked at lifestyle coaching involving diet, exercise, social engagement, stress reduction, and cognitive training.

The randomized, controlled trial, called Coaching for Cognition in Alzheimer’s, was conducted by the Institute for Systems Biology in Seattle. Researchers compared two cohorts of patients—one made up of 24 participants receiving standard care and the other made up of 31 participants who received standard care plus personalized coaching for lifestyle intervention. The coaching was conducted over the phone.

Along with cognitive exercises, participants followed dietary recommendations based on the MIND diet, physical activity recommendations based on US public health guidelines, and recommendations for sleep and stress management.

“The participants were all individuals with predementia or early Alzheimer’s,” Attarha explains. “It was found that those in the lifestyle intervention group showed roughly 63% less cognitive loss and roughly 40% less functional loss than the standard care group. What is so exciting about these results is that they demonstrate that the brain is a continuously changing organ—and that even brains that have begun the neurodegenerative process have retrained their plasticity and ability to change.”

According to Attarha, even if these interventions only delay the onset of diagnosis by one year, it may result in about nine million fewer cases by 2050.

Coaching for Sustainable Change
“We’ve all heard lifestyle advice again and again—to the point where it can get boring and easy to dismiss,” Attarha admits. “But there is simply no shortcut when it comes to brain health. Making lifestyle changes can alter cognitive decline and yet we know that many patients do not always stick to these changes. That’s why the coaching element is so important.”

She explains that the coaching component can be the differentiator that helps get people on board with these various interventions and keep them on track. The key is working with experts in each field. For instance, a registered dietitian would be the best coach for dietary changes, while someone certified in physical training would be optimal for exercise coaching.

“We might hit a wall and not know how to get around it. But a coach can guide us through those obstacles.” Attarha says. “In the future, my hope is that we’ll identify the smallest number of brain-healthy activities needed to drive the greatest cognitive benefit so that we can minimize patient burden and make these changes sustainable for everyone.” Remote-based coaching, she adds, is scalable in a way that pharmacological solutions are not. “Medication is expensive, limited in accessibility, and often undesirable as it is accompanied by unwanted side effects.”

Looking Ahead
The Alzheimer’s Association is investing heavily in lifestyle research. This includes a network of roughly 20 interventional trials to better understand how lifestyle changes can affect cognitive decline. Among them, the US POINTER study (PrOtect through a lifestyle INTErvention to Reduce risk) includes a closer look at brain training through BrainHQ, physical exercise, nutritional counseling and modification, cognitive and social stimulations, and improved self-management of medical conditions.

“The US POINTER study is still underway, but very soon we are going to have an even better picture about how lifestyle interventions and coaching can make a difference in cognitive decline,” Attarha says. “BrainHQ is involved in providing the cognitive training for some of this research.”

With this surge in lifestyle intervention research, Attarha says, there’s a need to start isolating each individual factor. “We know that a healthier lifestyle is associated with a decrease in cognitive decline,” she explains. “But now we want to isolate these individual factors—exercise, diet, cognitive training—and look at their relative contribution. We can then validate each component and understand how it contributes.”

In the future, Attarha would love to see brain health given the same attention as other areas of wellbeing. “When we go in for a physical, the doctor checks our blood pressure, listens to our lungs, and takes some standard bloodwork. What’s missing from this evaluation is our brain—our body’s control center and most vital organ,” Attarha says. “The field hasn’t yet made brain health part of our regular medical conversations.”

A key goal of Posit Science, Attarha says, is to see cognitive assessment as part of a standard medical check-up. “So often we see mild cognitive impairment go undiagnosed for years,” she continues. “By the time a patient is diagnosed there may have been a decade or two of unfolding pathology that was overlooked. But we are learning that those early years are a critical time for change. If it’s something that we start catching and treating earlier, there might be a chance for better outcomes.”

Brain Training Exercises
Posit Science and BrainHQ’s role in this research has been focused on how brain training exercises can build cognitive reserve and resilience,” Attarha says.

“A lesser-known fact is that the brain can regenerate and grow across a person’s lifespan—even in the presence of a disease like Alzheimer’s,” she says. “We’ve been looking specifically at how to build cognitive resilience with computerized brain training. We have exercises that train the speed and the accuracy of information processing. Our online app works by improving the speed and accuracy of what we see and hear, and it is based on decades of neuroscience research. Hundreds of studies have demonstrated its effectiveness.”

Some of its benefits include gains in cognition (attention, processing speed, memory, decision-making), in quality of life (depressive symptoms, confidence and control, and health-related quality of life), and in real-world activities (health outcomes, balance, and hearing).

“What the research seems to indicate is that people with a higher level of cognitive reserve—who have made their brains more resilient with some of these lifestyle interventions—may have fewer symptoms, even with significant pathology, like plaque,” Attarha explains. “Looking to the future, we want to continue to find ways to exercise our brains and build cognitive resilience.”

— Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.